Section A: Borrower Section:

Please complete all information in this section. Must be a U.S. Citizen or Permanent Resident Alien.
Loan Amount Requested -Tuition
Loan Repayment Term (years)
First Name
Last Name
Middle Initial
Jr./Sr.
Social Security Number
Drivers License Number
Street Address
Apt. # / Rural Route
City
State
Zip Code
Date of Birth (month/day/year)
Please Select One
How Long at Current Address
Years

Months
Own/Rent
Home Phone
Cell Phone
Email Address
Mailing Address (if different from Street Address above)
Apt. # / Rural Route
City
State
Zip
Landlord/Mortgage Holder Name
Landlord/Mortgage Holder Phone #
Monthly Mortgage/Rent Amount $
Approximate Balance (Mortgage only) $
Approximate Home Value (If you own) $
Employment Information
Work Phone
Employer Name
Position/Title
How Long at Current Employer Years Months
Employer Address
Employer City, State
Employer Zip Code
Other Income Source
Note: Include Spouse’s Income, Other Job, Rent, etc. You do not have to reveal alimony, child support or maintenance income unless you wish it to be considered as a basis for loan repayment.'
Other Income Amount $
Gross Annual Salary $
Previous Employer
How Long Years Months
First Reference
Reference Name (Do not use co-borrower)
Reference must be a US Citizen currently living at a different address than the Borrower.
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship
Second Reference
Reference Name (Do not use co-borrower)
Reference must be a US Citizen currently living at a different address than the Borrower.
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship
Third Reference
Reference Name (Do not use co-borrower)
Reference must be a US Citizen currently living at a different address than the Borrower.
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship

Section B: Co-Borrower Section:

Please complete all information in this section if applying jointly. Must be a U.S. Citizen or Permanent Resident Alien.
Relationship to Borrower
First Name
Last Name
Middle Initial
Jr./Sr.
Social Security Number
Drivers License Number
Street Address
Apt. # / Rural Route
City
State
Zip Code
Date of Birth (month/day/year)
Please Select One
How Long at Current Address Years Months
Own/Rent
Home Phone
Mailing Address (if different from Street Address above)
Apt. # / Rural Route
City
State
Zip
Landlord/Mortgage Holder Name
Landlord/Mortgage Holder Phone #
Email Address
Monthly Mortgage/Rent Amount $
Approximate Balance (Mortgage only) $
Approximate Home Value (If you own) $
Work Phone
Employer Name
Position/Title
How Long at Current Employer Years Months
Employer Address
Employer City, State
Employer Zip Code
Other Income Source
Note: Include Spouse’s Income, Other Job, Rent, etc. You do not have to reveal alimony, child support or maintenance income unless you wish it to be considered as a basis for loan repayment.
Other Income Amount $
Gross Annual Salary $
Previous Employer
How Long Years Months
Co-Borrower's First Reference
Reference Name (Do not use co-borrower)
Reference must be a US Citizen currently living at a different address than the Borrower.
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship
Co-Borrower's Second Reference
Reference Name (Do not use co-borrower)
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship
Co-Borrower's Third Reference
Reference Name (Do not use co-borrower)
Reference's Permanent Address
Apt. # / Rural Route
City
State
Zip
Reference's Home Phone
Relationship